Child Outcomes Completing the EDIS Child Outcomes Summary

Child Outcomes Completing the EDIS Child Outcomes Summary Form (COSF) Army EDIS Measuring Outcomes Initiative Module Two Army Educational and Developmental Intervention Services 1

Objectives Participants will… 1. understand assessment of functional outcomes. 2. learn how to complete the Army EDIS Child Outcomes Summary Form (COSF). 3. be familiar with the resources available to assist with completion of the Army EDIS COSF. 4. understand the team process for completing the Army EDIS COSF. 5. be able to enter child outcome data in the EDIS data system (Special Needs Program Management Information System - SNPMIS). Army Educational and Developmental Intervention Services 2

Functional Outcomes n n n Results of Early Intervention. Different from IFSP outcomes. Functional n n n Skills used meaningfully in the context of day-today life. Integrated behaviors to achieve goals. Not discrete behaviors. Army Educational and Developmental Intervention Services 3

Think Functionally Not just… within age-expected bounds But does he/she… n Shows a skill in a specific situation n Use a skill in actions across settings & situations to accomplish something meaningful to the child n Makes eye contact, smiles, & gives a hug n Initiate affectionate interaction toward caregivers & respond to others’ affection n Points at pictures in a book n Engage in play with books by pointing at & naming pictures n Uses a spoon n Use spoon to scoop up food & feed self at meals Army Educational and Developmental Intervention Services 4

Isolated or Functional? 1. Knows how to imitate a gesture when 2. 3. 4. 5. 6. prompted by others. Uses finger in pointing motion. Uses 2 word utterances Watches what a peer does and incorporates it into his play. Points to indicate wants or needs. Engages in back and forth verbal play exchanges with caregivers using 2 -word utterances. Army Educational and Developmental Intervention Services 5

Measuring Child Outcomes COSF – Key Features n It is not an assessment tool. n It uses information from assessments & observations to get a global sense of how the child is functioning across settings/situations at one point in time. n 7 -point rating scale. n Ratings are based on the child’s functioning compared with what is expected given the child’s age. Army Educational and Developmental Intervention Services 6

Measuring Child Outcomes Key Points n Children can be described with regard to how close they are to age expected behavior for each of the three outcomes. n Most children in the general population demonstrate the outcomes in an age-expected way. n By providing services and supports, early intervention is trying to move children closer to age-expected behavior. n Some children will never achieve this. Army Educational and Developmental Intervention Services 7

Essential Knowledge for Completing COSF Between them, team members must: I. Understand general age expectations for child development. II. Understand the content of the three child outcomes. III. Know how to use the COSF rating scale. Specific to the child being rated: IV. Know about the child’s functioning across settings and situations. V. Understand age expectations for the child’s functioning within the his/her culture. Army Educational and Developmental Intervention Services 8

I. Understand Age-Expected Development Army Educational and Developmental Intervention Services 9

Age-Expected Development n Generating a COSF rating requires thinking about a child's functioning in relationship to age-expected development. n Refer to resources that describe sequences and age expectations in child development. n Use of these resources can be helpful… n for teams as they consider the appropriate rating to describe a specific child's functioning. n as professionals communicate with family members about ratings. Army Educational and Developmental Intervention Services 10

The Concept of Foundational Skills n n In predictable ways, children’s earlier skills & behaviors serve as a foundation for the next higher level of functioning developmentally. Foundational Skills n n Earlier skills serve as the base & are conceptually linked to later skills. Children play along side one another before they interact in play. Skills become more complex as children get older. Immediate Foundational Skills n Just prior to age-expected functioning. Army Educational and Developmental Intervention Services 11

Observing Tyler… n n Tyler is 13 months old. How would you describe his skills and behaviors based upon what you see? n n n Are they age-expected? Immediate foundational? Or not yet? Army Educational and Developmental Intervention Services 12

Observing Tyler Army Educational and Developmental Intervention Services 13

II. Understand Content of the Three Child Outcomes Army Educational and Developmental Intervention Services 14

Children acquire & use knowledge & skills Children have positive social relationships Relating with adults Relating with other children Following group rules Thinking, reasoning, & problem solving Children take appropriate action to meet their needs Take care of basic needs Understanding symbols Understanding physical & social world Getting from place to place & using tools Contributing to own health & safety Army Educational and Developmental Intervention Services 15

Children acquire & use knowledge & skills Children have positive social relationships Relating with adults Relating with other children Following group rules Thinking, reasoning, & problem solving Children take appropriate action to meet their needs Take care of basic needs Understanding symbols Understanding physical & social world Getting from place to place & using tools Contributing to own health & safety Army Educational and Developmental Intervention Services 16

Observing Functional Development n Identify what the child is doing in terms of 1. Demonstrating positive social/emotional skills including social relationships 2. Acquiring and using knowledge and skills 3. Taking appropriate action to meet needs n n Consider Progression of Development Consider Functionality - skills/behaviors in context and across settings. Army Educational and Developmental Intervention Services 17

1. Positive Social Relationships n n n n n Demonstrate attachment Initiate & maintain social interactions Behave in a way that allows them to participate in a variety of settings & situations Demonstrate trust in others Regulate emotions Understand & follow rules Comply with familiar adult requests Share toys & materials with others Initiate, respond to, & sustain interactions with others as play partners Listen, watch, & follow activities during group time. 18

Developmental Progression 1. Positive Social Relationships with primary caregivers n n n Recognizes and reaches to primary caregiver Seeks to remain in company of primary caregiver Seeks primary caregiver as secure base in new situations Interacts with new people/situations when primary caregiver is nearby Functions with increasing comfort in a variety of situations Play with others n n n Watches & responds to other children Reaches out & engages momentarily with others Has brief play encounters with others Participates in longer play encounters playing with similar activities Participates in coordinated play with others Army Educational and Developmental Intervention Services 19

Observation & Discussion Prompts 1. Positive Social Relationships n How does the child… interact with & relate to others in day-to-day happenings n display, read and react to emotions n initiate, maintain, and close interactions n express delight or display affection n transition in routines or activities (familiar & new) n engage in a joint activities/interactions n show awareness of contextual rules expectations n respond to arrivals and departures of others n n …. . across different settings? Army Educational and Developmental Intervention Services 20

Positive Social Relationships a closer look n n Observing a 20 month old child. What is age expected in terms of social relationships skills and behaviors? n Relating to adults n Relating to other children n Following rules Army Educational and Developmental Intervention Services 21

Observing 20 Month Old Child Positive Social Relationships Army Educational and Developmental Intervention Services 22

2. Acquire & Use Knowledge & Skills n n n n Display curiosity & an eagerness for learning Explore their environment Explore & play with people & objects (toys, books, etc. ) Engage in appropriate play with toys & objects Use vocabulary either through spoken means, sign language, or through augmentative communication devices to communicate in an increasingly complex form Learn new skills & use these skills in play (e. g. , completing a puzzle or building a fort) Acquire & use the precursor skills that will allow them to begin to learn reading & mathematics in kindergarten Show imagination & creativity in play 23

Developmental Progression 2. Knowledge & Skills Learning about their environment n n n Visually exploring Mouthing toys Banging, dropping toys Combining toys – using toys functionally Pretending Expanding scheme in pretend play Problem solving n n n Awareness of a problem Imitates the way others solve problem - immediately Experiments with trial & error to solve simple problem Persists with trial & error to solve problem Intently carries out own plan for solving problem Army Educational and Developmental Intervention Services 24

Observation & Discussion Prompts 2. Knowledge & Skills n How does the child… n n n n imitate others and learn to try new things persist or modify strategies to achieve a desired end solve problems and attempt solutions others suggest use the words/skills he has in everyday settings understand respond to directions or requests display awareness of the distinction between things interact with books, pictures, print demonstrate understanding of familiar scripts in play n …. . across different settings? Army Educational and Developmental Intervention Services 25

Knowledge & Skills a closer look n n Observing a 30 month old child What is age expected in terms of acquiring and using knowledge and skills? n Thinking, reasoning, remembering n Problem solving n Using symbols and language Army Educational and Developmental Intervention Services 26

Observing 30 Month Old Child Knowledge & Skills Army Educational and Developmental Intervention Services 27

3. Take Action to Meet Needs n n n n Move from place to participate in activities, play, & routines. Seek help when necessary to move from place to place. Manipulate materials to participate in learning opportunities & be as Independent as possible. Use objects (e. g. , forks, sticks, crayons, clay, switches, other devices, etc. ) as tools in appropriate ways. Use gestures, sounds, words, signs or other means to communicate wants & needs. Meet self care needs (feeding, dressing, toileting, etc. ). Seek help when necessary to assist with basic care or other needs. Follow rules related to health & safety. 28

Developmental Progression 3. Action to Meet Needs Motoring about n n n Begins moving purposefully (rolling, sitting, crawling) Gains balance to move from place to place Walks forward with increasing coordination Attempts a variety of motor activities Balances while moving arms and legs in active play Self-care (dressing, undressing, eating, toileting) n n n Begins to participate as adult attends to personal needs Attempts simple personal care tasks Tries more complex personal care tasks with limited success Tries more complex personal care tasks with increasing success Does many personal care tasks successfully Expressing needs (hungry, thirsty, changing, toys) n Cries, vowel sounds, babbles, points/gestures, word-like sounds, single words, two-word phrases, simple sentences Army Educational and Developmental Intervention Services 29

Observation & Discussion Prompts 3. Action to Meet Needs n How does the child… across different settings? get from place to place n assist with or engage in dressing, eating, toileting, hygiene tasks n convey needs and desires and preferences n respond to challenges n respond to delays in getting what he wants n get what he wants (e. g. , toys, food, attention…) n show awareness of or respond to situations that may be dangerous n amuse himself or seek out something fun n Army Educational and Developmental Intervention Services 30

Action to Meet Needs a closer look n n Observing a 30 month old child What is expected in terms of ability to take appropriate action to meet needs? n Taking care of basic needs n Getting from place to place n Using tools Army Educational and Developmental Intervention Services 31

Observing 30 Month Old Child Meeting Needs Army Educational and Developmental Intervention Services 32

III. Know How to Use the COSF Rating Scale? Army Educational and Developmental Intervention Services 33

F S O S I C D E O C y E m r A y b d e s evi R Army Educational and Developmental Intervention Services 34

Army EDIS COSF Army Educational and Developmental Intervention Services 35

Parent Input Assessment Results Naturalistic Observation RBI COSF Single Rating for each of the 3 outcomes Professional Clinical Opinion Progress & More Army Educational and Developmental Intervention Services 36

Assessment There is no assessment tool that assesses the three outcomes directly. Army Educational and Developmental Intervention Services 37

Points of View n n n What any individual professional (or parent) “tunes into” depends on his/her orientation Training provides an “organizing framework” for how different professionals see the child. Each child is unique and has their own mix of behaviors, skills, capabilities, strengths, interests, and needs Army Educational and Developmental Intervention Services 38

Information for COSF n Being attune to “alternate domains of development” and the 3 Early Childhood Outcomes early on in the process is valuable for attaining a functional picture of the child relative to the 3 Outcomes. Completion of the COSF must include: n Information about the child’s present levels of functional integrated development n n Remember that information from the RBI is indispensable Naturalistic observation Parent input Team involvement Army Educational and Developmental Intervention Services 39

“The best way to understand the development of children is to observe their behavior in natural settings while they are interacting with familiar adults over prolonged periods of time. ” Urie Bronfenbrenner Army Educational and Developmental Intervention Services 40

COSF Questions n @ Initial, Annual, and Exit 1 a, 2 a, 3 a n n @ Annual and Exit (not @ initial) 1 b, 2 b, 3 b n n To what extent does the child show behaviors and skills related to each outcome appropriate for his/her age across a variety of settings and situations? (Rating: 1 – 7) Has the child shown any new skills or behaviors related to each outcome since the last outcomes summary? ( yes or no) Ratings are based on the child’s functioning: n n What the child does across settings and situations Compared with what is expected given the child’s age Army Educational and Developmental Intervention Services 41

Achievement of Each Child Outcome Army Educational and Developmental Intervention Services 42

Normal Points Curve Corresponding to on COSF Rating Scale 10 Army Educational and Developmental Intervention Services 43

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Ratings 7 7 n n 6 n n “Completely” and 6 Child shows functioning expected for his/her age in all or almost all everyday situations that are part of the child’s life. Functioning is considered appropriate for his/her age. No one has any concerns about the child’s functioning in this outcome area. Child’s functioning generally is considered appropriate for his/her age but there are some significant concerns about the child’s functioning in this outcome area. These concerns may be substantial enough to suggest monitoring or possible additional support. Although age-appropriate, the child’s functioning may border on not keeping pace with age expectations. Army Educational and Developmental Intervention Services 45

Distinguishing Ratings 7 vs. 6 n All children have strengths and weaknesses. Families and providers identify areas to work on to support ongoing growth (some call these “concerns”) n Concerns raised for which families and providers may want to offer extra support and strategies to promote development, but the area of concern is not a possible indicator or precursor of a significant developmental problem (7). n Developmental concerns-weaknesses significant enough to watch closely and definitely support. Although age expected now, the child’s development boarders on not keeping pace with age-expected levels or shows early signs of possible developmental problems (6). Re-screening children. Army Educational and Developmental Intervention Services 46

Ratings 5 5 n n 4 n “Somewhat” and 4 Child’s functioning expected for his/her age some of the time and/or in some situations. Child’s functioning is a mix of age appropriate and not age appropriate behaviors and skills. A child’s functioning might be described as like that of a slightly younger child. Child shows some but not much age-appropriate functioning. Army Educational and Developmental Intervention Services 47

Ratings 3 3 n n n 2 n “Emerging” and 2 Child does not yet show functioning expected of a child of his/her age in any situation. Child’s behaviors and skills include immediate foundational skills upon which to build age appropriate functioning. Child shows these immediate foundational skills most or all of the time across settings and situations. Functioning might be describes as like that of a younger child. Child’s behaviors and skills include some immediate foundational skills but these are not displayed very often across settings and situations. Army Educational and Developmental Intervention Services 48

Ratings 1 1 n n n “not yet” Child does not yet show functioning expected of a child his/her age in any situation. Child’s skills and behaviors also do not yet include any immediate foundational skills upon which to build age appropriate functioning. Child’s functioning might be described as that of a much younger child. Army Educational and Developmental Intervention Services 49

Relative to Each Outcome Think About… Worksheet Functioning that will lead to immediate foundational skills Functioning that shows immediate foundational skills Functioning that is age appropriate Age appropriate, but some concerns Atypical behavior, but not like that of a younger child Key behaviors or skills that are expected of children this age but are missing Army Educational and Developmental Intervention Services 50

Completing the COSF form n On the form, you will need to document n n n n n Child’s name Child’s DOB Rating date and which rating (initial, subsequent, exit) EDIS Program Location The consensus rating for each outcome If the child’s IFSP includes documentation to support ratings if not complete page 2 of COSF Persons involved in deciding the summary rating Evidence that led to the selected rating that is not included on the IFSP or in the child’s record (use page 2 of COSF) The form is filed in the child’s record under section 2 Army Educational and Developmental Intervention Services 51

IV. Know about the child’s functioning across settings and situations. Army Educational and Developmental Intervention Services 52

Practice Example – initial rating George “William” Wonder n Review case study materials 1. BDI Crosswalk (from ECO Oct. 07) 2. BDI Crosswalk completed for William 3. IFSP-PD including RBI for William 4. Video clip of William in a variety of situations Army Educational and Developmental Intervention Services 53

Meet William & His Family Army Educational and Developmental Intervention Services 54

William – Outcome 1 n What is William doing with regard to building social relationships and getting along with others? n n What are things he does when it comes to relating to adults? …How about relating to other children? Consider strengths and areas of concern. ECO Discussion Prompts Army Educational and Developmental Intervention Services 55

William – Outcome 1 n Documenting the Basis Worksheet What is William doing that is we would expect to see for children his age? n What is he doing that might be immediately foundational to age expected skills/behaviors? n What is he doing that will lead to immediate foundational skills? n What would we expect a child William’s to be doing in this area? n Is he demonstrating any atypical behaviors? Army Educational and Developmental Intervention Services 56

Army Educational and Developmental Intervention Services With numerical ratings Without numerical ratings Rating Table 1 – 7 The rating 57

Decision Tree Army Educational and Developmental Intervention Services 58

Decision Tree with & without numerical ratings Army Educational and Developmental Intervention Services 59

Documenting on the COSF Army Educational and Developmental Intervention Services 60

William – Outcome 2 n Discuss what is known about William with regards to outcome 2 n Examine (and record) William’s functioning on the “Documenting Basis Worksheet” n Decide on a rating using the rating table/decision tree n Note questions and issues that came up Army Educational and Developmental Intervention Services 61

William – Outcome 3 n Discuss what is known about William with regards to outcome 3 n Examine (and record) William’s functioning on the “Documenting Basis Worksheet” n Decide on a rating using the rating table/decision tree n Note questions and issues that came up Army Educational and Developmental Intervention Services 62

V. Understand age expectations for the child’s functioning within his/her culture. Army Educational and Developmental Intervention Services 63

Cultural Considerations n Know what behaviors and skills are appropriate for the child’s age within the context of the family and their culture. n Use the expectations for the child’s culture to decide if the child’s functioning is at the level expected. 64

Special Considerations n Very young children n Children with only speech/articulation delays n Assistive technology and accommodations Army Educational and Developmental Intervention Services 65

Team Consensus Challenges What if the team cannot reach consensus? n n n Focus discussion on child’s skills related to the outcome. Don’t go to selecting a rating number too quickly. Discuss rationales for differing ratings. Focus on concrete descriptions & how they support a particular rating. Include more discussion on typical development for a same age child. Army Educational and Developmental Intervention Services 66

Team Consensus Challenges n General Policy 1. Ensure all available information & resources are being used. 2. Seek additional information. 3. Call upon other resources to assist with the rating process. 4. Majority rules. Army Educational and Developmental Intervention Services 67

Team Scenario n Present what is known about the child and select one outcome to work through. n Discuss what is known about the child with regards to the chosen outcome n Discuss and record key points about the child’s functioning on the “Documenting Basis Worksheet” n Decide on a rating using the rating table/decision tree n Note questions and issues that came up n Share scenario with group Army Educational and Developmental Intervention Services 68

Including Parents in the Rating Meeting n n Team Member Information Provider n n Participant in the COSF rating discussion n Parent input is critical - COSF ratings rely on information about the functioning across situations and settings. Encouraged, but not required. When included use decision tree & rating table without numerical rating values Consumer n n Explain why the rating is being done and what in means. Refer to Measuring Outcomes tri-fold Army Educational and Developmental Intervention Services 69

Subsequent Ratings n Essentially the same procedure as entry n In addition, answer questions 1 b, 2 b, and 3 b ‘b’ questions address progress n n Any progress the child has made even if that progress does not give the child a higher rating on the scale. Compares child to his/her own past behavior. Small steps of progress count! Army Educational and Developmental Intervention Services 70

Initial Entry Entering Data in SNPMIS Army Educational and Developmental Intervention Services 71

Annual and Exit Entries Entering Data in SNPMIS Army Educational and Developmental Intervention Services 72

Quality Assurance Checks n After completing Module II training, each program will submit at least one completed COSF, accompanying documenting worksheet, and IFSP for review and feedback. n Share questions and ideas as they arise. n Frequently asked questions and answers will be published for sharing across the programs. Army Educational and Developmental Intervention Services 73

When & How Often Will Child Outcomes be Measured? n n n Begin collection now Include all new IFSPs n Within 30 days on either side of initial IFSP Thereafter n Exit outcome data for all children exiting that have had services at least 6 months & had a prior COSF n At Exit n n unless outcomes were measured within past 60 days unless the child was in the program less than 6 months Army Educational and Developmental Intervention Services 74

Way ahead n Timelines for implementation n Q 1 CY 2008 n n Q 2 CY 2008 n n n Training and Begin Collecting Child Outcomes Enter data in SNPMIS Quality Assurance Checks of Data Collection Continue Collecting Child Outcomes Training and Begin Collecting Family Outcomes Enter child and family outcome data in SNPMIS Quality Assurance Checks of Data Collection 1 July 2008 n n Full Implementation of Child and Family Outcomes across EDIS programs Quality Assurance Checks of Data Collection Continue Army Educational and Developmental Intervention Services 75

Please Share Your Ideas & Questions n What’s working & what’s not? What’s clear & what’s not? Are there ways to improve the process? n Contact n n Naomi. Younggren 2@us. army. mil Army Educational and Developmental Intervention Services 76